If injury, over-exertion, or coughing have caused muscle strain, your chest wall is often tender or painful when you press a finger at the location of the pain. This can often be treated at home. Try acetaminophen or ibuprofen, ice, heat, and rest.

If you know you have asthma or angina, follow the instructions of your doctor and take your medications regularly to avoid flare-ups.

Call 911 if:

• You have sudden crushing, squeezing, tightening, or pressure in your chest.
• Pain radiates to your jaw, left arm, or between your shoulder blades.
• You have nausea, dizziness, sweating, a racing heart, or shortness of breath.
• You know you have angina and your chest discomfort is suddenly more intense, brought on by lighter activity, or lasts longer than usual.
• Your angina symptoms occur at rest.
• You have sudden sharp chest pain with shortness of breath, especially after a long trip, a stretch of bedrest (for example, following an operation), or other lack of movement that can lead to a blood clot in your leg.

Know that your risk of heart attack is greater if you have a family history of heart disease, you smoke or use cocaine, or you have high cholesterol, high blood pressure, or diabetes.

Call your doctor if:

• You have a fever or a cough that produces yellow-green phlegm.
• Chest-wall pain persists for longer than 3 to 5 days.

Emergency measures will be taken, if necessary. Hospitalization will be required in difficult or serious cases or when the cause of the pain is unclear.

The doctor will perform a physical examination and monitor your vital signs (temperature, pulse, rate of breathing, blood pressure). The physical examination will focus on the chest wall, lungs, and heart. Your doctor may ask questions like the following:

• Is the pain between the shoulder blades? Under the breastbone? Does the pain change location? Is it on one side only?
• How would you describe the pain? (Severe, tearing or ripping, sharp, stabbing, burning, squeezing, constricting, tight, pressure-like, crushing, aching, dull, heavy)
• Does it come on suddenly? Does the pain occur at the same time each day?
• Is the pain getting worse? How long does the pain last?
• Does the pain go from your chest into your shoulder, arm, neck, jaw, or back?
• Is the pain worse when you are breathing deeply, coughing, eating, bending?
• When you are exercising? Is the pain better after you rest? Is it completely relieved or just less pain?
• Is the pain better after you take nitroglycerin medication? After you drink milk or take antacids? After belching?
• What other symptoms are also present?

Diagnostic tests that may be performed include:

• Blood tests (such as LDH, LDH isoenzymes, CPK, CPK isoenzymes, Troponin, CBC, and blood differential)
• Cardiac catheterization
• ECG
• Exercise ECG
• Lung scan
• X-rays of the chest

More complex tests may be required depending on the difficulty of diagnosis or the suspected cause of the chest pain.

Make healthy lifestyle choices to prevent chest pain from heart disease:

• Achieve and maintain normal weight.
• Control high blood pressure, high cholesterol, and diabetes.
• Avoid cigarette smoking and second-hand smoke.
• Eat a diet low in saturated and hydrogenated fats and cholesterol, and high in starches, fiber, fruits, and vegetables.
• Exercise 3 hours per week or more (such as 30 minutes per day, 6 days per week).
• Reduce stress.

Hong SN, Rhee PL, Kim JH et al. Does this patient have oesophageal motility abnormality or pathological acid reflux? Dig Liver Dis. 2005; 37(7):475-484.